Saturday, February 13, 2010

...Me first? Cunningham was not snatching a kidney away from someone else. Except for the story about her, there would have been no offer in the first place. Moreover, every so-called Good Samaritan donor who gives to someone like Cunningham or Tomas removes them from the queue, and so others move up a slot. No one is harmed while someone is saved.

Caplan is a bioethicist; his titles imply an expertise in ethics. Hanto served as the chair of the Ethics Committee at the American Society of Transplant Surgeons. Yet what are we to make of their willingness to issue life-and-death pronouncements involving other people? Well, we know a few things about them. First, that they share an absolutist approach to egalitarianism: If all cannot benefit, then none should benefit. Second, as ethicists they presume to know how despairing patients should conduct their private affairs. And third, they appear to have few qualms about conveying to desperately ill people a message of hopelessness: Be passive, dying patients — wait your turn and take no initiative to save your own life.

Does being a bioethicist entitle one to any such moral authority, edifying the rest of us about right and wrong? Is this what society should expect of its “ethics experts”?

The proper relationship between experts and citizens is a question of longstanding interest to sociologists and social critics. In the case of bioethicists, the nature of the subject about which they claim authority is up for debate. Traditionally, they have focused on the controversies surrounding biomedical technology, such as cloning, sex selection, in vitro fertilization, nanotechnology, research ethics, organ allocation, and so on. Now experts are calling for involvement in policy. Renee Fox and Judith P. Swazey, senior scholars who have studied the sociology and history of bioethics, urge a focus on “inequalities in health and in access to health care in America.” The field is too “narrowly American-ocentric,” they write in their 2008 book Observing Bioethics; it should become “more centrally and deeply involved with [global] suffering and issues of social justice.” In his new book The Future of Bioethics, Howard Brody, a physician and philosopher at the University of Texas Medical Branch, instructs bioethicists to gauge success by asking themselves if they are “speaking truth to power.” These prescriptions presume a moral authority that bioethicists cannot properly claim.

Origins

Where did bioethicists come from? Ethical conundrums in medicine long predated the creation of the field now known as bioethics. In his respected book The Birth of Bioethics, Albert R. Jonsen, a moral theologian and bioethicist, dates the origin of bioethics as a distinct discipline to 1947, the year that 23 physicians were convicted of war crimes during the Nuremberg tribunal. Others believe the field grew out of postwar technological capabilities that intensified the already vexing dilemmas about human control over life and death. Medical controversies over care for the terminally ill, reproductive technology, genetic manipulation, and organ transplantation drew the attention of Catholic theologians and other religious scholars in the 1950s and 1960s. In concert with philosophically inclined physicians and scientists, they began to apply moral theory to modern medical controversies. The exploration of these issues soon became more secularized as historians, philosophers, anthropologists, legal scholars, and others joined in.

At the same time it became clear that as technology enhanced physicians' therapeutic powers, it increased the range of interventions that patients could undergo and the vulnerability that came from not understanding the risks of those interventions. This recognition brought questions about doctors' duty to inform patients about the treatments prescribed, the alternatives available, the patient's prognosis, and the right to refuse care. A backlash against medical paternalism that was already underway in the 1960s began to attract academics who were engaged in the civil rights and antiwar movements and harbored a keen distrust of institutions; they trained their sights on resetting the balance of power between physicians and patients.

As ethical quandaries multiplied and demanded attention, it was perhaps inevitable that a specialized group of professionals — the bioethicists — would emerge to meet the task. In an impressive burst of institution-building that was funded by both the federal government and private philanthropies, three bioethics think tanks sprang up between 1969 and 1971: the Hastings Center, in upstate New York; the now defunct Society for Health and Human Values, in Philadelphia; and the Kennedy Institute of Ethics at Georgetown University, a Jesuit institute, in Washington. Populated by physicians, legal scholars, philosophers, historians, and humanists, their agendas coalesced around cutting-edge issues such as genetic testing, organ transplants, in vitro fertilization, neonatal intensive care units, euthanasia, and other conundrums surrounding death and dying. And when, in the 1970s, research scandals at Willowbrook and Tuskegee erupted, research ethics and regulatory oversight were added to the bioethics portfolio.

Inhabitants of the ivory tower were eager to make themselves relevant by applying theory to real-world problems. According to Daniel Callahan, one of the founders of the Hastings Center, he and his colleagues wanted to give philosophy “some social bite, some 'relevance.'” In 1982, in an article called “How Medicine Saved the Life of Ethics,” the philosopher and historian Stephen Toulmin argued that the imperatives of medicine enabled moral philosophy to avoid the academic sidelines. And there is no question that, in some cases, physicians themselves turned to theologians and moral philosophers for help...

The baby boomers had everything – free education, free health care and remarkable personal liberties – but they squandered it all. Now their children are paying for it

The baby boomers were a golden generation. Rich people have always had opportunities, but for the ordinary man and woman there had never been a time of hope and opportunity like the one we baby boomers inherited. We were the Beveridge generation. The 1942 Beveridge report called for the abolition of the "five giants" - want, ignorance, disease, squalor and idleness. Between 1945 and 1951, despite a war-ruined economy, the Attlee government took Beveridge as its agenda and set about the first systematic assault on each of the giants.

Baby boomers were born between the end of the war in 1945 and Winston Churchill's resignation as prime minister in 1955, and the world they grew up in was shaped by Beveridge. We baby boomers had everything.

First, and most important, we had education. Before the Second World War, almost a third of Britons could not read or write. Many of those who could write did so slowly and haltingly, as one performs a complicated and unaccustomed task. My grandmother, born in the 1880s, was a rather wise old lady, so I remember the sense of shock I felt when, as a teenager, I received a letter from her and realised she wrote like a five-year-old. We, Britain's baby boomers, are the first generation in which pretty well everyone can read and write fairly fluently.

We were the first generation for which university education was not a privilege of wealth. In the Sixties, for the first time, proletarian and regional accents were heard throughout the British university system, and (except in a few backward-looking institutions) their owners were no longer made to feel out of place. We grew up at a time when, as Neil Kinnock told the Labour party conference in 1987, he was "the first Kinnock in a thousand generations" to have the chance to better himself.

The idea that one might have to pay for education, at any level, seemed to us primitive and backward-looking. In the Thirties, my grandmother used to save pennies in a tin in her kitchen, fearfully guarding against the day when one of her children might require medical attention. In the week that the National Health Service was inaugurated in 1948, GPs' surgeries were overwhelmed with patients whose painful and often life-threatening conditions had never been treated or even shown to a doctor. When we baby boomers were ill, we expected, as a right, the best treatment available. Paying for it never occurred to us.

There was full employment, and the slums were torn down and replaced with council housing, built to Aneurin Bevan's high standard. And what did we do with this extraordinary inheritance that had eluded our ancestors, and that an earlier generation had worked and fought to give us?

We trashed it.

We trashed it because we did not value it. We trashed it because we knew no history, so we thought our new freedoms were the natural order of things. It was as though we decided that the freedom and lack of worry that we had inherited was too good for our children, and we pulled up the ladder we had climbed.

For many, the idea of Palestinian resistance is synonymous with terrorism, conjuring up images of suicide bombings and rockets. This is a distortion shaped by the media and our politicians.

Beyond the headlines, Palestinian resistance has always included nonviolent tactics.

Today, in rural villages from Bilin and Jayyous to Nilin and Beit Ommar, this kind of Palestinian persistence against Israel's separation barrier and illegal settlements is paying off – and attracting the participation of international supporters and Jewish Israelis.

Palestinians have been using classic nonviolent strategies such as strikes, demonstrations, and civil disobedience since before the modern state of Israel came into being in 1948. But recently, new momentum, fresh media attention, and an increasingly harsh crackdown by Israeli occupation forces have thrust these strategies into the spotlight.

This newfound attention, however, comes with a danger of double standards, and a distortion of the root causes of the conflict.

For example, Western media and politicians cheer the rise of nonviolent Palestinian resistance, but why do they not urge Israel to adopt the same nonviolent standards? Why is it only Israel that is repeatedly granted the “right of self-defense”? The hypocrisy is heightened because it is the Palestinians who are fighting to secure basic rights such as self-determination.

The core of the conflict is not Israel's “security” but rather decades-old Israeli policies designed to ensure the domination of one group at the expense of another. So it is a critical error to think that by renouncing armed struggle, the Palestinians could change Israel's fundamental goals.

But that's not stopping the protesters from challenging the occupation. Israel's escalating crackdown suggests that the movement is not only already considered a threat to Israel's apartheid-style rule, but also has the potential to develop into something more important. In recent months, Israel has targeted leaders such as Jamal Juma, Mohammed Khatib, Mohammad Othman, and Abdullah Abu Rahme with detention without trial and trumped-up charges.

Mr. Othman, who was snatched by Israeli troops and kept in prison for 106 days without charges, says that the strength of the popular resistance – “an initiative from every farmer, every Palestinian who can't access their land, and not belonging to any political party” – has shaken the Israeli military into launching this wave of raids and abductions.

Israel, which markets itself as the region's only democracy, has also snatched dozens of villagers in night raids over the past 18 months. Since 2005, 18 Palestinians have been killed and more than 1,500 have been injured in antiwall protests

The Pentagon's mad science arm may have come up with its most radical project yet. Darpa is looking to re-write the laws of evolution to the military's advantage, creating “synthetic organisms” that can live forever — or can be killed with the flick of a molecular switch.

As part of its budget for the next year, Darpa is investing $6 million into a project called BioDesign, with the goal of eliminating “the randomness of natural evolutionary advancement.” The plan would assemble the latest bio-tech knowledge to come up with living, breathing creatures that are genetically engineered to “produce the intended biological effect.” Darpa wants the organisms to be fortified with molecules that bolster cell resistance to death, so that the lab-monsters can “ultimately be programmed to live indefinitely.”

Of course, Darpa's got to prevent the super-species from being swayed to do enemy work — so they'll encode loyalty right into DNA, by developing genetically programmed locks to create “tamper proof” cells. Plus, the synthetic organism will be traceable, using some kind of DNA manipulation, “similar to a serial number on a handgun.” And if that doesn't work, don't worry. In case Darpa's plan somehow goes horribly awry, they're also tossing in a last-resort, genetically-coded kill switch:

Develop strategies to create a synthetic organism “self-destruct” option to be implemented upon nefarious removal of organism.

The project comes as Darpa also plans to throw $20 million into a new synthetic biology program, and $7.5 million into “increasing by several decades the speed with which we sequence, analyze and functionally edit cellular genomes.”

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Roots

Revelation 13

And I stood upon the sand of the sea, and saw a beast rise up out of the sea, having seven heads and ten horns, and upon his horns ten crowns, and upon his heads the name of blasphemy...

...And they worshipped the dragon which gave power unto the beast: and they worshipped the beast, saying, Who is like unto the beast? who is able to make war with him?...

Mark 13

And when ye shall hear of wars and rumours of wars, be ye not troubled: for such things must needs be; but the end shall not be yet. For nation shall rise against nation, and kingdom against kingdom: and there shall be earthquakes in divers places, and there shall be famines and troubles: these are the beginnings of sorrows.